Weekly Covid-19 Updates
Webinar series hosted by Dr Terri Lovis and Dr Pavan Uppal – sharing learning between Primary and Secondary care around COVID19. Recordings and slides available here.
Returning to work during Covid-19
- Unsure about what is expected of you as you return to work?
- Overwhelmed with all the guidelines you need to read?
- Have any concerns about returning?
This webinar series will help GPs, ANPs, PAs and GP trainees return to work.
GP Trainees and GP trainers should access all three webinars.
Qualified primary care staff without responsibility for a GP Trainee should access Sessions A and B.
A general overview, bringing you up to date with the latest COVID guidelines and changes to clinical practice for returning to work during Covid-19 as well as resources to support your own wellbeing.
In this session Dr Terri Lovis covered:
• What you need to know about Covid-19 before returning to work
• The move to full telephone or digital triage
• Top tips for telephone and digital consultations
• CPR during Covid-19
• Looking after your own wellbeing
Access the recording here.
An update on palliative care and death certification during Covid-19.
In this session Dr Terri Lovis covered:
• Palliative care during Covid-19
• Death certification and new rules
Access the recording here.
For GP Trainees returning to work, Dr Terri Lovis and Prof Chris Warwick covered:
• How do you access Supported Return to Training funding?
• What will your working week look like?
• What has happened to CSA / AKT?
• What do you need to do about your eportfolio?
• Due to CCT? When will you qualify? How?
• Will you be re-deployed to ITU?
Access the recording here.
Resources to help with telephone & video consultations
Using Video Consultation
Quick telephone consult tips
Video consultation tips for GPs
Latest Guidance on PPE
The latest guidance on personal protective equipment can be found here
Update on infection control guidance for hot sites and home visiting
Click here to view ‘Primary Care Covid-19 Hot Hubs and Home Visiting Guidance’ on Infection Prevention and Control.
Guide for Sussex Practices on how to order PPE
Click here to view the new steps for ordering PPE as of 30.04.20
Infection Prevention and Control Support
Support and guidance for infection prevention and control, including hot hubs, are available here.This includes:
FAQs on management of patients with COPD have been updated in line with the COVID-19 rapid guideline: community-based care of patients with chronic obstructive pulmonary disease (COPD). Please clink on the links below to view these:
Information about provision of Monitored Dosage Systems to patients during COVID 19 can be found at the following link:
The following new information is available:
- Community Pharmacy – Medicine collection and delivery
- Community Pharmacy – Changes to opening hours during Covid-19
- OptimiseRx – Review of messages during the Pandemic
Sexual Health Services
West CCG specific information
Sexual Health and Contraception services: Many of our staff have been redeployed however we continue to operate a limited STI testing & treatment, contraception and HIV treatment and care service in our hub clinics during this time. Therefore, please do continue to refer patients to our service, however please ask them to contact us via our central booking number 01903 285199 so that patients can be triaged to see if we can meet their needs at this time.
HIV and COVID 19: www.bhiva.org/Coronavirus-COVID-19
Unfortunately all our patients with HIV have received the standard Government text telling them to shield. This is contrary to national guidance and the established evidence which shows that the majority of our patients do not have an increased risk of acquiring COVID-19 nor a more severe disease course if they do. We have a few patients with a CD4 count <50 or a recent opportunistic infection who are assumed to be at increased risk. They have been contacted by our team and advised to shield. The rest of our patients are advised to follow standard national guidance about social distancing unless they have any other comorbidities which require them to shield.
Antiretroviral drug interactions: Please use the ‘interaction checker’ to check for potential harmful drug interactions with antiretrovirals when prescribing or contact our on call consultant via St Richards Hospital or Worthing Hospital switchboard for advice.
Cervical Screening Programme
Click here for NHS Cervical Screening Programme Guidance for the current COVID situation
In summary it recommends that :
- Practices aim to sustain a normal cervical screening service during this time.
- If unable to do so, it is recommended that practices reschedule appointments rather than cancel. This can be in 6 months’ time for routine smears, and 3 months for those with previous abnormalities.
- It is recommended an appointment is booked rather than requesting patients to call back.
Further advice is given within the document regarding:
- Individuals who pass their 65th birthday during this time, Colposcopy referrals, Training requirements, How to prioritise patient requests
There is also a patient information leaflet “Helping You Decide” available here.
Safeguarding Guidance for Sussex CCGs Primary Care during the COVID-19 pandemic
Please find here guidance on safeguarding during the pandemic, including:
- RCGP guidance on safeguarding which has helpful advice on safeguarding when consulting remotely and useful national resources
- Information on baby checks, fever in children, private fostering arrangements, access to Health Visiting and School Nursing Services
Wellbeing and Councelling
Relate counselling during the COVID-19 pandemic
Relate provides counselling on all aspects of relationships, for individuals, couples, families and children and young people aged 11 to 19.
Although Relate’s face-to-face work has stopped, they are still here to provide counselling and support both online and by telephone, and one-off counselling sessions, for people who may be experiencing anxiety and stress, due to the current situation.
More information is available here or to make an appointment you can phone one of the following numbers or alternatively email the service:
- Crawley, Horsham and East Grinstead
Mondays to Fridays 9am to 5pm 07799 170582 or 07423 147915 or email firstname.lastname@example.org
Resilience and Mental Health Virtual Masterclasses via Zoom
The Mid-Downs Training Hub have organised wellbeing training sessions which are open to all staff, both clinical and non-clinical, working in GP practices across Sussex.
The World Health Organization has warned that the Covid-19 outbreak is globally generating stress. Mental health charities are reporting an increase in calls. Never before has there been a more important time to protect our emotional health and wellbeing.
Each of these highly interactive virtual masterclasses have been carefully designed to focus on the proactive steps that can be taken to ensure good emotional health. For leaders to understand how to protect their health and that of their team members, and for individuals to recognise what they can do to care for themselves and others during these unprecedented times.
Resilience: the essentials
This one hour introductory workshop will help you understand resilience and how the current Covid-19 situation is impacting on this and the support and action you take to help you cope during a period of great uncertainty. The concept of the psychology of change will be explored along with the implications this has for those working remotely. Ways of managing pressure and stress along with some quick tips that will help you build your resilience will also be shared.
Regulating emotions and coping mechanisms
This one hour workshop will provide some practical strategies that will help you learn ways of avoiding the stress response. This is of particular relevance in the current environment which has been acknowledged as greatly increasing the chance of stress taking hold, and with this, the emergence, or exacerbation of existing mental health conditions. Included are 6 quick emotion regulation techniques that can be applied to retain a sense of control and balance in challenging situations and advice regarding helpful and unhelpful coping choices to make when facing pressured working conditions, including remote working.
These workshops have now taken place but if you would be interested in either of the above workshops please let us know by emailing email@example.com as we would be happy to run them again if there is enough interest.
Additional support for people needing urgent help with their mental health
People across Sussex struggling with their mental health during the coronavirus outbreak are being offered additional telephone and crisis support to help them cope. Sussex Partnership NHS Foundation Trust has expanded the Sussex Mental Healthline – 0300 5000 101 – to provide a 24/7 service to people needing urgent help with their mental health.
As well as crisis support it will provide psychological support to people who have general concerns about their mental health.
South East Health and Wellbeing Resources
Click here to view a number of resources which will help you to support staff health and wellbeing and look after yourself as the NHS in the South East responds to COVID-19.
#HAY – #How Are You Guide
Caring for our staff is a key leadership responsibility, as well as a moral one. This new Guide, produced by NHS England and NHS Improvement South East and written for NHS leaders, managers and staff across the region, shows how we can take regular, practical steps to look out for each other.
There are seven elements to the guide:
o Ensuring that we get a break and take time off – and that we model this ourselves
o Advice on managing fear, for ourselves and our colleagues
o Coping strategies: how we can ground ourselves through focusing on our senses
o Spotting early warning signs of stress, and having wellbeing conversations
o Focusing on morale, so that your leadership has a positive impact for everyone
o Providing space for staff to take time out and decompress
o Having #HAY conversations with staff absent due to COVID-19
You can download the #HAY Guide here and the accompanying letter here. If you want to get a head start, here is a quick two-page visual that summarises the elements, and helps you keep a record of how you’re doing. And there are six annexes that go into more detail on specific issues:
o Annex A: what to include in a decompression/wellbeing space
o Annex B: how to conduct wellbeing meetings
o Annex C: templates and other help on managing risks arising from trauma (TRiM)
o Annex D: templates to follow when contacting absent staff
o Annex E: managing and supporting vulnerable and high-risk staff
o Annex F: check-ins and check-outs with staff
Psychological wellbeing during the Covid-19 pandemic – Guidance for Staff
There are some simple things you can do to look after your mental health and wellbeing at the current time. Looking after your mind and body will help you both at work and home. Click here to view the guidance written by NHS England and NHS Improvement.
‘Supporting psychological wellbeing during Covid 19 – A practical webinar for frontline staff’
Click here to view a webinar organised by NHS England and NHS Improvement with the aim of supporting the wellbeing and mental health of staff working in primary care settings across the South East Region.
The speakers are Dr Katrina Lake, Adult Mental Health Clinical Lead and Catherine Randall, Deputy Head of Safeguarding, NHS England and Improvement.
The presentation from the session can be found here.
Supporting Line Managers
We hope that some of our line managers (as well as team members) were able to join the webinar yesterday and hear the useful information about managing teams through remote working. We also talked about Wellness Action Plans which are a great tool for supporting the wellbeing of your staff
Colin Simmons, Integrated Urgent Care Programme Director for Sussex, shared with us his experience of managing his team through remote working. In particular he spoke about the importance of seeing home as just another office, and set up clear systems and ways of working.
Wellness Action Plans are a simple tool that guide conversations about what keeps us well at work so that we can continue to do our job to the best of our ability whilst also looking after our mental health. Everyone is different and everyone has different needs that help them thrive. Some teams are already using the plans but we are keen to hear from new teams that would like to start using them. We will work will you and offer further workshops and dedicated support where helpful. If that is something that is of interest to you please contact the people team via firstname.lastname@example.org in the first instance. If you would prefer to chat to someone about what wellness plans might offer you or your team and/or explore the idea further, please contact Lin Hughes via email@example.com
You can find more information on Wellness Action Plans, alongside a wealth of other resources for line managers on our intranet here
And don’t forget you can always check in to the People Response Team Covid-19 intranet page for updates and support at any time, including requesting a direct telephone call back from the team if you need support.
To support our people coping with bereavement we have shared a number of new resources on our wellbeing intranet page. Bereavement can take many shapes and forms and you don’t have to have personally experienced it to feel grief.
Leading through Covid-19: supporting health and care leaders in unprecedented times
The Kings Fund has pulled together some quick-read practical guides and videos to support to health and care leaders during the pandemic. The information is updated regularly on their website.
The psychological wellbeing of staff during the Covid-19 pandemic – Guidance for Managers and Leaders
The Covid-19 pandemic presents significant challenges for healthcare staff. Good leadership and management of staff is important in helping staff deal with the psychological demands that are being placed on them. Click here for guidance on some of the things that can help when managing and leading teams.
Support for staff and teams during COVID-19 – A brief manager’s guide
Click here to view a document written by The Oxford Health Psychosocial Response Group which details the different forms of support which are available to staff and teams. The key message behind this document is that there are a range of options and resources available to support you and your teams both now and into the longer term.
Advance Care Planning
Update from the BMA:
The BMA has previously issued a joint statement with the RCGP, CQC and the Care Provider Association which we have shared with you before, about the importance of continuing with advance care planning during the COVID-19 emergency. For those patients who are at greater risk of developing severe illness from the virus, discussions about their wishes and preferences with regard to future care and treatment has taken on increased importance and should be carried out in the correct way.
We, therefore, want to highlight again that, when developing advanced care plans with patients, practices should adhere to some key principles:
- Careful consideration needs to be given to which patients may specifically benefit from having these discussions at this time, based on relevant clinical factors.
- All discussions must be tailored to the individual circumstances of the patient.
- It is unacceptable for blanket decisions about advance care plans, and decisions about DNACPR (do not attempt cardiopulmonary resuscitation), to be applied to particular groups of people.
- Care needs to be taken when considering how patients are first contacted with a view to initiating these discussions.
- Discussions need to be managed sensitively and compassionately, ensuring that patients understand why they have been contacted and what they are being invited to do.
- When discussing the possible treatment options in the event of them becoming ill with COVID-19, it is important that patients are not given the impression that decisions about access to intensive treatment will be made on the basis of age or disability. It should be made clear that every patient will be considered individually based on clinically relevant factors, such as their physical ability to benefit from the complex and demanding treatment provided in intensive care.
- While patients should be encouraged to think about their wishes for future care and treatment, they must not be put under pressure to do so, or to reach a particular decision.
We would be very grateful if you can ensure these principles have, and continue to be followed in any discussions with patients around DNACPR and Advance Care Plans.
There have been no changes to the Mental Capacity Act in light of the pandemic and therefore if a patient is deemed to lack capacity and has no family or NOK then you must still involve an IMCA (Independent Mental Capacity Advocate) as per the Mental Capacity Act. This is a legal requirement.
Further information about IMCAs can be found here.
Guidance from the Resus Council and a joint statement from the BMA and RCN about DNACPR decisions for patients who lack capacity states:
10.3 Adults who lack capacity and have no family, friends or other advocate who it is appropriate to consult In England and Wales, the Mental Capacity Act 2005 requires consultation with an independent mental capacity advocate (IMCA) regarding all decisions made by an NHS body or Local Authority about ‘serious medical treatment’, where people lack capacity and have nobody to speak on their behalf. The definition of serious medical treatment includes circumstances where “what is proposed would be likely to involve serious consequence for the patient”. Neither the Act, nor the code of practice, differentiates between decisions made purely on clinical grounds (i.e. because the treatment will not work) and those that involve broader best-interests considerations (i.e. balancing benefits against potential harms and burdens). If a CPR decision is needed when an IMCA is not available, the decision should be made, the reasons for it should be documented in the health record and an IMCA should be consulted at the first available opportunity. An IMCA does not have the power to make a decision about CPR but must be consulted by the clinician responsible for the person’s care as part of the determination of that person’s best interests.
The full document including patients with family and friends or Lasting Power of Attorney can be found here.
POhWER is the organisation that provides access to IMCAs in Sussex and their helpline is 0300 456 2370.
Alternatively, there is an e-referral form which can be found here.
POhWER operate across Sussex and have advised that an IMCA can provide a report for an individual without capacity within 2-3 days of receiving the referral. During the pandemic they are not visiting in person but calling the care homes and GP, and any other relevant organisations that are providing care and support to the individual. They also have the capacity to look at several referrals for one care home and still respond within the same time frame so access to an IMCA should not be a barrier to working within the Mental Capacity Act.
If an individual without capacity is clearly approaching End of Life (i.e. actively dying) then contacting an IMCA should not result in delays if not having a DNACPR in place potentially leaves the individual at risk of an unnecessary procedure. However, this rational should be documented clearly in the records, and in discussion with the care home staff, and an IMCA should still be contacted via POhWER on the helpline number above but in these circumstances you can put a DNACPR in place whilst you contact the IMCA.
If practices have any questions or need any further support or guidance, especially around patients without capacity or with learning disabilities, please contact the primary care team who can arrange for someone from the relevant team to contact you directly to discuss further.
NHS Bowel Cancer Screening – COVID-19
Summary of new guidance – NHS Bowel Cancer Screening COVID-19 Task and Finish Group FAQs
Full guidance available here.
The NHS is rescheduling all screening appointments for bowel cancer.
As an FAQ, this document is aimed mostly at the screening centres themselves and includes 25 pages of comprehensive technical advice.
Key principles for the bowel cancer screening programme
- People should be asked not to complete their screening test kit at this time, even if they have received a kit, but will be notified when it is safe to do so.
- If people do complete their screening kit and send it into the screening hub, the test kit will be processed, and a result issued to the participant.
- If someone needs further investigations, every effort will be made by the screening hub to deliver appointments over the telephone.
- If the assessment is more than 6 weeks before the diagnostic test, a courtesy check call will be made to clarify if the health status remains the same e.g ask questions about any symptoms including whether or not they may be at risk of obstruction, and will be managed accordingly.
This document includes 50 FAQs, covering both primary and secondary care, screening hubs and testing kits, including advice on what to do if the test is positive, or patient has symptoms, but doesn’t have a follow up appointment.
Service level updates for BSUH
Sleep Studies Service
Please note that due to staffing levels, the Sleep Studies Service at Brighton and Sussex University Hospitals NHS Trust (BSUH) has been suspended until further notice. This suspension of service is not a COVID-19 related issue.
Currently there is no timeframe for when this service will be back online. BSUH will work with other Trusts to develop a strategy for offering a Sleep Studies service post COVID-19.
All patients currently awaiting CPAP set-ups, Sleep Studies or Outpatient appointments have been advised of cancellations, and will be prioritised once the service recommences.
Until the service recommences, BSUH will not be accepting any new referrals. Please see the below table for alternative Sleep Studies Services:
|General Sleep Issues (Inc Sleep Apnoea)||Sleep Apnoea Only|
|Western Sussex (refer via Respiratory)||x|
|East Surrey (SaSH)||x|
Diabetes and Endocrinology
- We are not currently able to offer a telephone advice service via Switchboard
- We will continue to offer an Advice and Guidance service for endocrinology
- For other queries, please contact our endocrinology secretaries are on 01273 696955 x 64311 or e-mail firstname.lastname@example.org – who will pass the messages on to us.
- The antenatal diabetes management clinic and diabetes foot clinics will continue to run with face-to-face consultations where necessary, unless patients are advised otherwise.
- For all other endocrinology and diabetes clinics, we are trying to provide telephone consultations instead of face-to-face appointments, but are having to cancel/re-schedule some clinics.
- Patients may not be phoned at exactly the same time as their booked appointment, and may not be consulting their usual doctor.
Endocrine surgery & radioiodine therapy:
- In relation to radioiodine therapy for an overactive thyroid, thyroid and parathyroid surgery: this is all being deferred till post COVID-19, and we are managing patients medically.
- At present our Neurosurgeons are not doing any transsphenoidal surgery for pituitary patients, however new pituitary patients should still be referred.
Patient support group information:
The patient support groups all have very helpful advice for patients on their websites:
Pituitary disease: https://pituitary.org.uk/news/2020/03/coronavirus-advice/
Addison’s disease: https://www.addisonsdisease.org.uk/news/novel-coronavirus-covid-19
Nurse-led Rapid Access Chest Pain Clinic
Until further notice, the RSCH and PRH nurse-led Nurse Led Rapid Access Chest Pain Clinics will be operating only on initial virtual Phone call assessments.
As part of the referral process you must include:
- An ECG. If this is not possible please arrange as below
- Auscultation assessment for murmurs, as we will request an echo if one is heard
- Blood Pressure measurement
ECG Walk-in Service – for B&H GPs only
During this time we are not able to offer a 12 lead ECG walk-in service. If you wish to send a patient for an ECG please ensure they have the relevant paperwork, i.e. a request in the form of a letter and ask them to ring the department for an appointment. The number to call is 01273 696955 Ext 3918.
Care of the elderly community
The RSCH Care of the Elderly Consultants will be providing increased telephone advice to our Community Partners during the Covid-19 outbreak.
We will extend our advice from GPs predominately to Nursing Home Managers, Paramedic Practitioners, Community Nurses and other Allied Health Professionals involved in Community Frailty Care.
A reminder too that we will still be managing a large volume of non Covid-19 cases.
PLEASE CONTACT THE PROFESSIONAL SUPPORT LINE ON 0300 130 3045
BETWEEN 08.00-19.00 MONDAY TO FRIDAY
AND 08.00-17.00 SATURDAY AND SUNDAY FOR CONSULTANT ADVICE
You will be asked:
- Does you patient require admission?
2. Do you require telephone advice only?
You will then be directed to a Care of the Elderly Consultant
PSL record all telephone calls which provides reassurance for all practitioners using this telephone advice service.
What is GP Connect?
Sharing Medical Records through GPConnect will allow not only CCAS to reference the clinical record, but will also allow patients to be treated more safely at another practice or care facility. This means that if your practice were to close or if your patient presented elsewhere, for example at a ‘hot hub’ or out-of-hours service, they can always be treated with access to their medical history, which will be both safer and faster than treating a patient without this information. GPConnect not only allows read only record viewing TPP to TPP and EMIS to EMIS, but also between EMIS and TPP systems. It does not yet include Vision practices. The system provides a lot more information than the Summary Care Record however not everything; letters for example cannot be viewed.
Actions to Enable GPConnect on your clinical system
To enable clinical systems to support interoperability with the CCAS as described, GP Practices must:
- Enable GP Connect for both appointment booking and record access.
- Ensure worklist appointment slots are available on your clinical system into which the CCAS can ‘book’ patients.
There are instructions on how to enable GP Connect for both TPP (available here) and EMIS (available here) Clinical systems. Whilst we had expected both TPP and EMIS to enable this centrally on behalf of their practices we understand that this has not yet happened so practices are advised that they should now do this themselves, using the guidance provided.
Practices also need to create the worklist appointment slots in their own systems to receive the call back referrals (this cannot be done centrally).
If you need help with to enable GP Connect on your clinical system, the digital team is happy to take you through it email@example.com
NHS urges public to get essential vaccines despite Coronavirus outbreak
NHS England is urging people to attend all regular vaccination appointments to prevent outbreaks of serious diseases and reduce pressure on the health service.
The NHS is continuing to help people to manage illness linked to coronavirus, but is still urging parents to bring children forward for lifesaving jabs to stop killer diseases like measles and mumps.
Essential, routine vaccinations like the MMR jab can save a child’s life and are available through family doctors, including in some parts of the country through new children’s immunisation drive-through clinics.
As long as those attending appointments, including parents of babies or children, do not have symptoms or are not self-isolating because someone in the household is displaying symptoms, all scheduled vaccinations should go ahead as normal.
A full list of vaccinations and when they are available, for children and adults, is accessible through the NHS website.
NHS Volunteer Responders
As a reminder, you can still refer any patients who might need support while self-isolating to NHS Volunteer Responders for help with tasks such as collecting shopping and prescribed medicines or driving patients to medical appointments. The scheme is already helping thousands of people every day. You can make referrals through the NHS Volunteer Responders referrers’ portal or by calling 0808 196 3382.
We are encouraging primary care networks to seek to establish networks of volunteers and link with social prescribing link workers.
The scheme will soon be open for self-referrals. People who have been advised to shield can ask volunteers for short-term help by calling 0808 196 3646 between 8am – 8pm. Please pass this number on to your patients who could benefit from this support.